Page 45 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma
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                                Non-pharmacological treatments for severe asthma
Bronchial thermoplasty
Thermoplasty has been proposed as a promising new option in the treatment of severe asthma [185]. The first studies suggested that this intervention could improve lung function (FEV1 and morning peak flow), airways hyperresponsiveness, asthma related quality of life and symptom scores [186;187]. Unfortunately, subsequent multicentre controlled trials in patients with moderate and severe asthma failed to show an effect on FEV1 and airway responsiveness, but suggested a favourable effect on exacerbations and hospitalizations [188]. The results of a 5 years follow up of these patients have confirmed the long term safety of the procedure, without long-term complications and maintenance of stable lung function [189]. Therefore, thermoplasty might be an option for some patients who do not respond to pharmacological treatment but it is still not clear which asthma phenotypes and which clinical outcomes benefit most of it.
High altitude treatment
Prolonged hospitalization of patients with severe asthma at high altitude might be of benefit to patients with allergic and non allergic phenotypes of severe refractory asthma [34;190]. The high-altitude climate offers more than decreased levels of HDM allergens. It also offers decreased exposure to pollens, fungal spores and air pollution, as well as lower work of breathing, relief from stress and high UV-light exposure with a potential immunomodulatory effect [191]. A rehabilitation program at high altitude might be a good treatment option for patients who remain uncontrolled despite maximal recommended treatment, irrespective of the asthma phenotype.
General conclusions and future perspectives
The evaluation of difficult-to-treat severe asthma patients should ideally take place in a specialized asthma centre with expertise in dealing with these patients. This includes a multidisciplinary team of physicians, nurses, and respiratory therapists. In every patient with severe asthma the diagnosis of asthma should be confirmed, adherence with therapy and inhalation
Current treatment of severe asthma
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